Posted by MERM on 6/6/2008, 9:37 am
Definition of fibromyalgia
The condition called “fibromyalgia” is a myofascial pain syndrome (a muscular pain syndrome) that can result in generalized back pain and muscle pain, a feeling of general fatigue, and specific tender areas. The patient will have a normal neurological exam, but may have multiple spots that are tender to palpation, called "tender points". These tender points are specific places on the neck, shoulders, back, hips, arms, and legs. These points hurt when pressure is put on them.
Fibromyalgia most commonly affects middle-age women who are otherwise healthy. However, the condition can affect women of all ages, as well as men and children.
While there is no known anatomical reason for the syndrome, it is suspected that there are underlying biochemical causes.
Fibromyalgia symptoms
People with fibromyalgia often have other symptoms in addition to specific tender points, and common symptoms may include one or some combination of the following:
Difficulty sleeping
Feeling tired after waking from sleep, instead of feeling refreshed
Stiff joints in the morning that usually feel better as the day goes on
Headaches
Tingling or numbness in hands and feet
Depression
Fibromyalgia treatment
Physicians who treat fibromyalgia typically include family physicians, general internists, or rheumatologists (who specialize in treating painful conditions that involve the joints, muscles, tendons and ligaments). Often a team of healthcare professionals is the best option to treat the diverse symptoms of fibromyalgia.
For example, treatment for fibromyalgia may include one or a combination of the following options:
Massage or injections of lidocaine may be used to help relieve the pain in tender spots
Non-narcotic pain medications (e.g. acetaminophen)
Low-impact aerobic conditioning
Antidepressants (e.g. Amytriptiline), both for help with sleeping and to alleviate the pain
On June 21, 2007, the FDA approved Lyrica (pregabalin) as the first medication specifically indicated to treat fibromyalgia pain. Lyrica is an analgesic (pain relief medication) and anticonvulsant medication that is also approved to treat neuropathic pain.
In the clinical trial submitted to the FDA, 30% to 60% of study participants with fibromyalgia experienced significant pain relief while taking Lyrica. The mechanism of action of how Lyrica works to reduce pain in patients with fibromyalgia is not exactly known; it is thought that the drug may impact how chemicals in the brain transmit signals to communicate between neurons.
There are a number of potential risks and side effects with Lyrica, including but not limited to:
Weight gain
Dizziness, sleepiness
Blurry vision
Impaired motor function
Swelling of the hands and feet
Fibromyalgia symptoms are quite common but non-specific. However, the constellation of symptoms can often suggest a diagnosis of fibromyalgia.
Main symptoms of fibromyalgia
The four cardinal features of fibromyalgia include:
Pain
The "pain" is typically widespread or generalized and often axial (such as low back pain). It is interpreted to be deep and muscular in origin and the patient may also report subjective weakness.
Approximately 25% of fibromyalgia patients report "poor circulation" or numbness and tingling which is not in a radicular pattern and typically involves arms and hands. However, a physical examination reveals normal muscle strength and sensory testing, with no inflammatory or arthritic features.
Stiffness
Stiffness is also a reported by many fibromyalgia patients and is generally widespread and diffuse. As in other rheumatic diseases, the stiffness is typically worse in the morning, may improve as the day progresses, but is exacerbated the day after physical exertion or exercise. Unlike some rheumatic diseases, however, the pain seldom limits one's ability to get out of bed
Fatigue
Fatigue is often the problem that the fibromyalgia patient first describes to the physician. It may be interpreted as a lack of physical endurance or a dearth of psychic energy or initiation 4. The patient may experience short periods of energy (such as for 24 to 48 hours), only to rebound into feeling fatigued and tired again. While this symptom is common, it is not universal.
Non-restorative sleep
Fibromyalgia patients typically wake up in the morning feeling tired. While this symptom is rarely offered as a complaint by the patient, it is often readily acknowledged upon questioning (e.g. "Do you feel refreshed upon awakening?"). Again, while this symptom is common, it is not universal.
Modulating factors of fibromyalgia
All of these symptoms are further highlighted by typical modulating factors. Fibromyalgia patients generally note exacerbation with some or all of the following factors:
Cold, damp weather
Stress
Overexertion
The reverse is also true – patients feel better with warm weather, hot baths, or even vacations from home or work. Almost all patients have tried a variety of non-steroidal anti-inflammatory medications (NSAID’s), but without benefit.
In a study of 50 matched controls, certain associated conditions were found to be unusually common for fibromyalgia patients. This study showed that a relatively high percent of fibromyalgia patients also had:
Anxiety disorders – 70%
Irritable bowel syndrome (IBS) – 34%
Migraine headaches – 22%
Additionally, Raynaud’s syndrome, dysmenorrhea and irritable bladder were common findings Until recently, the lack of a unifying etiology (the study of the causes and origins of the condition), and the lack of an accepted terminology, has hindered the understanding and recognition of fibromyalgia. Over the years, fibromyalgia has undergone a "conceptual evolution"
Early fibromyalgia studies
Descriptions of fibromyalgia can be found dating back to the early 1800’s. In 1904, pathologist Ralph Stockman first reported evidence of inflammatory changes in the fibrous, intra-muscular septa (a thin membrane that divides two soft masses of tissue) on biopsies from patients .
Also in 1904, Sir William Gowers introduced the term "Fibrositis" to describe the inflammation of fibrous tissue in his description of low back pain. However, subsequent studies of muscle biopsies have failed to reproduce Stockman’s findings of inflammation, and the term "fibrositis" is therefore considered a misnomer.
In subsequent years, the terms fibrositis, fibromyositis, psychogenic, psychosomatic, or muscular rheumatism have all been used as descriptors for this syndrome. Yet the term fibrositis has been most resilient and "eventually became synonymous with idiopathic local or diffuse musculoskeletal pain of any type" .
Modern classification of fibromyalgia
In the 1970’s, the researcher Hench first introduced the term "fibromyalgia". He noted that "muscle as well as ligamentous and tendonous connective tissues are usually subjectively involved."
Subsequently, in the 1980’s, another researcher, Yunus, furthered clarification of fibromyalgia by proposing the need for a unified classification system as well as the first diagnostic criteria .
Finally, in 1990, the American College of Rheumatology established firm criteria for the classification and diagnosis of fibromyalgia
Obtaining an accurate diagnosis of fibromyalgia
With the exception of tender points, the physical examination may be unrevealing because the patient’s symptoms are common and non-specific (e.g. fatigue).
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